Stress Fracture of the Foot

(Also known as Foot Stress Fractures)

What is a stress fracture of the foot?

A stress fracture of the foot is a condition characterized by an incomplete crack in one of the foot bones.

The foot comprises of many small bones 7 of which are located in the rear foot and are collectively known as the tarsals. The mid foot comprises of 5 long bones known as the metatarsals. The toes each comprise of several small bones known as the phalanges (figure 1). Each bone within the foot forms joints with adjacent bones.

Figure 1 – Relevant Anatomy for a Stress Fracture of the Foot

The bones of the foot provide attachment points for many muscles of the lower leg and foot. When these muscles contract, a pulling force is exerted on the respective bone. In addition, weight bearing activity places stress on the bones of the foot. When these forces are excessive or too repetitive, and beyond what the bones of the foot can withstand, bony damage can gradually occur. This may initially result in a bony stress reaction, however, with continued damage may progress to a stress fracture of the foot.

Cause of a stress fracture of the foot

A stress fracture of the foot typically occurs over time with excessive weight bearing activity such as distance running, sprinting, jumping or dancing. They often occur following a recent increase in activity or change in training conditions (such as surface, footwear or technique changes etc). A stress fracture of the foot may sometimes occur traumatically such as landing onto a hard surface from a height.

Signs and symptoms of a stress fracture of the foot

Patients with this condition typically experience a localized pain in the foot, toes or ankle that increases with impact activity (such as running, jumping, sprinting and hopping) and may decrease with rest. As symptoms worsen, the patient may limp during weight bearing activity and may have to stop activity due to pain.

Occasionally, pain may radiate to other areas of the foot that are not specifically involved in the injury. In severe cases, walking or standing may be enough to aggravate symptoms. Other symptoms may include night ache or pain on firmly touching the affected bone.

Diagnosis of a stress fracture of the foot

A thorough subjective and objective examination from a physiotherapist may be sufficient to diagnose a foot stress fracture. Further investigations such as an X-ray, MRI, CT scan or bone scan are usually required to confirm diagnosis and determine the severity of injury.

Prognosis of a stress fracture of the foot

With appropriate physiotherapy management, most patients with a stress fracture of the foot can make a full recovery (return to sport or full activities) in a period of 3 – 9 months. In more severe cases, recovery may take 1 year, or longer, depending on the intervention required and a range of other factors. In rare cases, some patients may experience ongoing symptoms or complications which may require further management.

Treatment for a stress fracture of the foot

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Contributing factors to the development of a stress fracture of the foot

There are several factors which may contribute to the development of a foot stress fracture. These need to be assessed and corrected with direction from the treating physiotherapist. Some of these factors include:

inappropriate or excessive training (particularly on hard or uneven surfaces)

Other intervention for a stress fracture of the foot

Despite appropriate physiotherapy management, some patients with a stress fracture of the foot do not improve and require other intervention to ensure an optimal outcome. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, extended periods of plaster cast immobilization, use of crutches or protective boot, review with a podiatrist for possible orthotics or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the stress fracture of the foot. Occasionally, patients with this condition may require surgery to stabilize the stress fracture and aid healing.

Exercises for a stress fracture of the foot

The following exercises are commonly prescribed to patients with a stress fracture of the foot following the initial period of immobilisation. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2 – 3 times daily once the physiotherapist has indicated it is safe to do so and only provided they do not cause or increase symptoms.

Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms

Initial Exercises

Foot & Ankle Up & Down

Move your foot and ankle up and down as far as possible and comfortable without pain (figure 2). Repeat 10 – 20 times provided there is no increase in symptoms.

Figure 2 – Foot & Ankle Up & Down (left foot)

Foot & Ankle In & Out

Move your foot and ankle in and out as far as possible and comfortable without pain (figure 3). Repeat 10 – 20 times provided there is no increase in symptoms.

Figure 3 – Foot & Ankle In & Out (right foot)

Foot and Ankle Circles

Move your foot and ankle in a circle as large as possible and comfortable without pain (figure 4). Repeat 10 – 20 times in both clockwise and anticlockwise directions provided there is no increase in symptoms.

Figure 4 – Foot & Ankle Circles

Intermediate Exercises

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